Hi, my name is Matthew: teen huff, I'm a gynecologic surgeon at cedars-sinai Medical Center in Los Angeles California. Today, I'm going to talk a little bit about manual Morse elation. At this point, we're ready to place the guard. I don't think you have to use a guard, but I think it's very helpful to have something hard to cut against if you're not going to use a guard, I think you risk cutting the bag with the scalpel. It'S fairly easy to do so. I think it's a helpful thing to use it has these little ridges here and that helps us grip on to the edges of the ring and we're just going to roll this up until it's small enough to fit inside and the incision. If https://www.techtricksclub.net/best-silent-gaming-mouse/ want to, you can put like a Kelly clamp on there to hold it in position, we're just going to place it inside the incision and let it naturally expand. And then there are these little locks that are at different points and you're going to want to lock it into the correct size for your incision. https://www.techtricksclub.net/best-satellite-speakers/ is to grab the tissue. If you just have a little bit of tissue exposed, you might want to use like a single tooth tenaculum to sort of pull it up just to where the tissue is exposed and then get a better bite with a second clamp. I'Ll. Do that here and then take off that first, one that didn't have very much tissue in it and then you really want to pull up a lot. You want to use sort of maximum amount of tension on this tissue. What I often see people doing when they're. First, starting is sort of cut down in this direction, and what you really want to do is pull up a lot on the tissue and then go sort of parallel to the abdominal wall and what that's gon na do is allowed to come out in a longer Strip so I'm gon na pull really hard with my non-dominant hand, I'm right-handed, so I've got my left hand on the clamp here. I'M gon na pull really hard on the tissue and then I'm gon na take my scalpel and I'm gon na go not entirely 360 degrees around, but most of the way. So I'm going to sort of pull on it like this and I'm gon na go parallel to the abdominal wall and I'm sort of rocking my left hand. As I go to expose more of that tissue, and then I just rock it back and I'm gon na go just a little bit further down and I'm gon na make a similar, similar circular incision rocking the tissue back and forth rock it towards me exposed the Next layer and then I'm gon na sort of rotate the tissue around as I go and it starts to come into a strip, and I don't want to go exactly that same line as I pull it toward me upward and toward me. I'M gon na go with it just sort of the next line down and then I'll start getting it to roll like this. So rotating sort rocking the tissue back and forth to expose the next layer and if you get so sort of a thin bridge of tissue or if your strip just kind of gets long, that's a good time to place a new clamp and you can take the Other one off, if you want you, can leave it on. If you've got a bunch of clamps, it can be helpful as you're kind of going along to remove a portion of the tissue and then just reach down and grab with a new clamp. So I'm putting a lot of traction up again that tissue is filling the entire incision that I've got here. I'M going parallel to the abdomen rocking the tissue back and forth. I rock it toward me an upward make a semicircular incision, nearly parallel with the abdominal wall, and that's going to allow this to sort of come out in a long strip and that's probably the most efficient way to remove this tissue when you're going through miami trium. This goes pretty quickly, but when you've got a hard, solid, calcified fibroid, it can be tempting again to sort of cut down into it. What you really want to do is reach down and grab a portion of that fibroid and rock it up, so that you can expose some of it and cut your next layer and the easiest way to do that is with this technique. If I rock it back and forth so with a lot of traction, pulling up, I'm going to rock it over get to where my next incision is going to be, and then, as I start to come around, I rock it this way and go most of the Way around, and that starts to get it into strips, rather than tear this off, I'm going to reach down with a new clamp if you get it in multiple pieces, that's fine! But it's kind of nice. If you can get it in a single, continuous strip and there we go, but the whole piece removed in one single, continuous strip, you